Social Worker Discharge Planner

Must have a minimum of Bachelors degree
Some duties:

• Formulate, implement, evaluate, and modify a clinically sound plan of

care for the patient discharge.

• Interview patients, families and significant others, and evaluate the

precipitating admission factors, emotional and psychological problems,
available personal/community support systems, relevant family dynamics and financial/legal issues relative to discharge planning.

• Coordinate all discharge planning with families, interdisciplinary

treatment team, agencies, and other community resources.

• Formulate therapeutic relationships and provide education to

patients, families, and individuals relative to discharge planning and
aftercare.

• Participate effectively in multidisciplinary treatment plan reviews,

demonstrating adequate preparation and understanding of patient issues, progress, areas of resistance, positive and negative strategies, etc.

• Link patient with internal and external resources as needed to meet

patient needs

• Assist families in finding resources to help themselves and follow up

with families

• Displays an ability to effectively communicate with courts, probation

officers, or other members of legal system when applicable

• Prepare patient to maintain recovery post-discharge
• Maintain clinical records according to program policies and those of
• Develop a discharge plan that meets patient needs for ongoing support
• Demonstrates knowledge of insurance providers.

licensing and accrediting agencies.

• Filling out NOMNCS (Notice of Medicare Non-Coverage) form and assist patients with appeals
• Working together with MDS, Social Worker and other team members to ensure discharge go smoothly and effectively.